Buying marijuana Bagamoyo

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Buying marijuana Bagamoyo

Official websites use. Share sensitive information only on official, secure websites. This work is published and licensed by Dove Medical Press Limited. By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed. For permission for commercial use of this work, please see paragraphs 4. Antenatal health information enables pregnant women to make informed choices for their health during pregnancy and childbirth. Worldwide, evidence shows inadequate coverage of the information provided to women during antenatal care visits. Interaction between women and providers is important to ensure effective information exchange. Formative explorative research using in-depth interviews was conducted with eleven Kiswahili-speaking women who had normal pregnancies and had more than three antenatal contacts. Also, five nurse-midwives who worked in the ANC clinic for a year or more were included in the study. A thematic analysis based on descriptive phenomenology guided the analysis of data that was informed by the WHO quality of care framework. Two major themes emerged from the data, enhancing communication and respectful delivery of ANC information and receiving information about pregnancy care and safe childbirth. We found that women felt free to communicate and interact with midwives. Some women feared interacting with midwives and other midwives were difficult to approach. All women acknowledge receiving antenatal care information. However, not all women reported receiving all ANC information as per national and international guidelines. Inadequate staffing and time were the reasons for poor prenatal care information delivery. The inadequate number of nurse-midwives, increased number of clients, and insufficient time were reported to contribute to inadequate provision of information during antenatal care. Strategies for effective provision of information during antenatal contacts should be considered including using group antenatal care and information communication technology. Further, nurse-midwives should be sufficiently deployed and motivated. Keywords: antenatal care, health information, pregnant women, maternal and infant mortality, Tanzania. Antenatal care ANC helps early identification of high-risk pregnancies and educates women for positive labour outcomes. In ANC, women are provided with education and counselling, screening of diseases, and treatment to ensure better outcomes for the mother and fetus. Maternal and infant mortality in Tanzania have remained high over the years despite various measures to reduce it. In , maternal deaths accounted for per , women. For example, in , there were 39 perinatal, 25 neonatal, 43 infants, and 67 under-five deaths per live birth. Tanzania government has implemented various interventions to reduce maternal and neonatal mortality rates. In , maternal and reproductive health services were established which was followed by several approaches and programs including Expanded Program on Immunization, 7 , 8 the Safe motherhood initiative 8 and Integrated Management of Child Illness In the WHO quality of maternal and newborn care framework, the process of care is divided into two main categories, the provision of care and experience of care. The provision of routine evidence-based care includes management of complications, actionable information and efficient referral system. The experience of care focuses on effective communication, provision of dignified and respectful care and emotional support. It also fosters an environment conducive for learning and changing behavior for positive pregnancy outcomes. This paper is informed by the WHO quality of maternal and newborn care framework, focusing primarily on the experience of the care. Effective communication between nurse-midwives and pregnant women ensures positive relationships, fosters a sense of reassurance, comfort and warmth. The positive relationship reduces negative emotion and may promote health practices among pregnant women. Evidence shows inadequate coverage of information and counselling provided in antenatal care clinics. Other studies in Africa 19 and the USA 20 have reported the significance of health information during antenatal care and acknowledged inadequate coverage and quality of education and counselling provided in antenatal care clinics. However, a few studies in Tanzania have reported about experiences of communication and information provided to women during pregnancy. The findings identified the way women and nurse midwives view the communication process and care, elicit gaps and challenges involved in care interaction, and suggest ways to improve communication during the care process in an antenatal clinic. The relevance of addressing this question of how pregnant women and nurse midwives in Tanzania feel about communication and getting information and care at the ANC clinic is to ensure that we get evidence-based information to enable the improvement of communication and interaction during antenatal care, an area that is problematic in Tanzania. The study was conducted in two districts of the Coast region of Tanzania, Kibaha and Bagamoyo districts. These districts were purposefully selected for the feasibility of group antenatal care intervention. In addition, Kibaha district was a semi-urban and Bagamoyo district was a rural setting, and both are close to Dar es Salaam commercial city of Tanzania. The three health centres were chosen because of their high rates of ANC attendance. The antenatal contacts were scheduled from 7. Because of shortage of staff, each unit was served by only one nurse midwife. Kerege health center antenatal clinic was highly understaffed with three midwives, while Mkoani health center antenatal clinic had 8 midwives and Mlandizi 7 nurse-midwives. Health education is the first activity provided in the health centre before other services begun, which was commonly done to all women who will be present during the time. After health education, women will head to receive other services including physical examination and laboratory tests. Understanding the impact of ANC information provided by nurse midwives in the context of increased number of clients and shortage of providers, especially nurse midwives, 27 the authors wanted to learn from the participants the content of ANC information and communication between nurse midwives and women, and identify barriers to effective communication for designing strategies ensuring that appropriate and relevant content of ANC information is well understood by women hence improved experiences of childbirth and positive birth outcomes. Participants for this study were purposively recruited. It was expected that women who have made more antenatal contacts are likely to have had adequate information about antenatal care. To gain diverse experiences women with varied characteristics in age, parity and level of education were considered. Enrolled nurse-midwives in Tanzania are those with a certificate in nursing and midwifery education and registered nurse midwives have at least a diploma in nursing and midwifery. All participants provided written informed consent after they understood the purpose of the study, issues of confidentiality and voluntary nature of their participation in the study. In addition, participants were informed that their interviews would be audio recorded and agreed for their anonymous quotes to be used in publication. We conducted 16 face-to-face in-depth interviews IDI , 30 eleven with pregnant women and five with nurse-midwives using an IDI guide. The IDI guide included topics and questions on ANC information gained from the literature review and the tools were extensively reviewed by the research team before use. During interviews, women shared their perspectives on ANC information they received from nurse-midwives including health promotion messages, how they interacted with providers and feedback on care they received. On the other hand, nurse-midwives reported their perspectives on ANC information they provided to women, interactions they have had with women during antenatal care. Both were assistant lecturers in a public University. Interviews were conducted in Kiswahili and were audio recorded using a Sony digital recorder except for one interview with a nurse midwife who did not consent for her interview to be recorded. At the end of each interview, the researchers listened to the recorded conversations and reflected on them and made sure that emerged themes were followed up with subsequent interviews. We analyzed data using thematic analysis, 33—35 a flexible method of data analysis that allows researchers with various methodological backgrounds to participate. The recorded interviews were transcribed verbatim in Kiswahili by the first author RH then a few transcriptions were cross-checked by other members of the research team. However, before coding the English translated transcripts were back translated into Kiswahili to ensure accuracy and completeness of translations against the original notes. A few observed discrepancies in translation were corrected accordingly. Transcripts were then read repeatedly to gain the sense of the information about pregnancy care and childbirth that was provided by the nurse-midwives and that reported by the women to have received during their visits to antenatal clinics. A list of potential and initial codes was generated, discussed and agreed on by the research team. Throughout the analysis process, the relevant texts were compared, checked, and rechecked for similarities and differences between the codes to form categories that reflected the manifest content of the text. The naming of categories was reflected and revised accordingly. The social and demographic characteristics of the pregnant women are presented in Table 1. Nurse-midwives were between the age of 30—59 with a median of 53 years. Two-third of nurse-midwives were enrolled and the rest were registered with diploma in nursing. Nurse midwives had worked at ANC between 2 and 28 years. Two major themes emerged from the data: Enhancing communication and respectful delivery of ANC Information and Receiving information about pregnancy care and safe childbirth. See Table 2. Also, it is followed by age and working experience. This theme has three subthemes and six categories. Also, it describes how respect and dignity were observed and maintained during interactions, as well as the need for an environment free of abuse. Women freedom to communicate is key for the providers to understand their needs and concerns and support them appropriately, women reported that during ANC care, they were free to ask questions, talk and interact with nurse midwives and other care providers at any time. I am so free here, let me tell no lie; I am free to ask anything, talk, and get good service. PW: Age 30, Multipara: Para 2. Other women thought that nurse-midwives were too busy for a productive interaction, and some were not easily approachable. I decided to request her telephone number; so that if I have something to ask, I can ask. In truth, she gave me the number. I just give them clients my phone number. For those who do not have a phone, I tell them, even if you find me on the street, just stop me. If you have a problem, tell me. RNM, Age 50 with 28 years of experience. Nurse-midwives ensured that information is provided to women respectfully and with dignity to build trustworthiness which is important in health care. Nurse midwives believed that their interaction and communication with women was done in a respectful manner. Although they were unsure whether what they were doing was perceived by women as respect. It is the pregnant women as they perceive the nurse-midwife. It depends on how the pregnant woman perceives you. Women reported elements that show respectful treatment and dignified care. These included being humble, responding to questions, welcoming, being patient when talking to them and not yelling at them. PW: Age 27, Multi: Para 2. Some women are free, and if they have something to say, they come directly to you, but some are fearful, thinking, what answer will I get if I ask? It is how a person thinks, if she is ready to talk, I am open to talk. ENM, Age 55 with 28 years of experience. Women in this study also acknowledged receiving verbal abuse from the nurse midwives that interfered effective communication and care provision. Other women, however, perceived verbal abuse as the outcome of circumstances nurse-midwives are going through, which may have led to using unpleasant language:. Some nurses are harsh. If you try to ask a question, they harass you verbally. I am not free to ask questions because some midwives may reply badly. I am afraid to ask questions. PW: Age 19, Nullipara. You know, the days are not the same, you may find one day she may be harsh to patients, but another day, she is relaxed with a sense of humility. Every person is not perfect, you see. I can wake up in the morning and become very harsh with my children until they ask themselves what is happening to their mum. But on another day, I am very humble to my children, so this is how we live with our nurses. PW: Age30, Multi: Para 8. Women were given ANC information to help them care for their pregnancies, prepare for labor and delivery and care for their children. They received information about nutrition, physical activity, examination results, danger signs during pregnancy and labour, risky health behaviors, stress management and preparation for delivery. Women reported that information about the importance of eating a balanced diet was commonly emphasized in the first ANC contacts. Women were encouraged to eat plenty of vegetables and fruits, less fat and salt and drink plenty of water. They Nurse-midwives informed us that we need to eat a balanced diet. We were informed during the first visit, … They recommend stiff porridge, vegetables, fish, meat, and things like that; eat plenty of vegetables because they help to increase blood and enough fruits, yes like that. PW: Age 30, Multi: Para 2. Nurse midwives encouraged women to eat more frequently during pregnancy, eating foods that are available in their areas and using nutrition supplements:. We tell them to eat mixed foods especially vegetables to increase the blood levels. Although most women acknowledged receiving information about nutrition during pregnancy, other women reported that they did not receive information about food and nutrition during ANC contacts. Ever since I started this clinic, I have never been told anything about what I should eat or not eat. PW: Age19, Nullipara. Both pregnant women and nurse midwives reported that child nutrition education and care was mostly provided during postnatal care. The ANC guidelines direct nutrition education to be provided in late antenatal contacts. It was, however, reported that information about child nutrition and the importance of exclusive breast-feeding was always provided to women who were HIV positive. We talk less about child nutrition. After delivery, the mother is instructed to exclusively breastfeed the child for six months, after that time the baby could be given soft foods like porridge. Physical exercises during pregnancy help women to remain active and therefore nurse midwives informed women to continue with their domestic chores as part of exercises and do other simple physical exercises:. A pregnant woman is supposed to do her routine chores if she does not have any problems. Do her simple activities like cooking, washing dishes, and household chores that do not use a lot of energy. Some women, however, acknowledged not receiving information about the importance of doing exercise during pregnancy. And others relied on their friends and parents who had experience of giving birth. PW: Age 20, Nullipara. Women recalled being informed about danger signs and what to do if they experienced each one of them. They were told to go to the nearby health facility if they had a foul-smelling vaginal discharge, vaginal bleeding, severe headache, dizziness, swollen legs or abdominal pain. They informed me that danger signs include bad smell vaginal discharge, severe headaches, and a baby who is not playing and when I experience them, I should go to the hospital. PW: Age 24, Multi: Para 1. So, we try to talk to both woman and her partner so that they both understand the danger signs that may happen and what to do. The element that was mostly recalled by women was the preparation of essential items needed for a clean birth. When we came for the first time, we were informed of the need to prepare delivery supplies like, ten pairs of khanga, a bucket of water, and other things that need to be on standby at home. PW: Age27, Multi: Para 2. Understanding the signs of true labor is one of the key information to ensure that women get to the health facility timely and increase the chances of women giving birth in the health facilities. However, women received this information from their mothers and friends. The women explained how they understood the signs of labor. PW: Age 24, Multi: Para1. The nurse-midwives thought that for the women who were pregnant for the first time it was a must to inform them about signs of labor and show them how to give birth. We tell them about signs of labor, especially women with their first pregnancy; we also tell them how they will notice signs of labor and tell her how she will give birth …. Nurse-midwives claimed to inform women about the test results. Sometimes reagents or kits for routine tests were lacking; therefore, women were advised to do the tests in a private laboratory. If the blood-increasing supplements were not available, women were advised to obtain them from a private pharmacy. I had my blood level tested. They told me my blood level is low. They gave me blood-increasing tablets. Today, the midwife told me there are no blood-increasing drugs, I will buy them. Since I have not tested my blood level and therefore I do not know my blood level. So, if the tests reveal no problems, you should give them the information. Sometimes the reagents are not available, but for the first visit of a pregnant woman, you can advise the mother to go does it somewhere else. We ask them to do it in the neighboring laboratories, which are private. NM: ENM, age 55 with 25 years of experience. This meant testing for and talking about possible risks to pregnancy and how to fix them. Although women recalled not being informed about risk behaviors during pregnancy, they knew that using cigarettes, alcohol, marijuana, and other illicit drugs could harm them and their unborn child. Other women reported receiving advice about risky behaviors from the elderly, friends, and family members. They may be talking about risk behaviors, but I have never been informed by them providers ; I know it is not good to use alcohol or cigarettes during pregnancy. PW: Age39, Multi: Para 4. My parents said that if you continue using alcohol and cigarette, your child will also use alcohol and cigarette in the future. We do not talk much about risk behaviors during pregnancy that is not our priority, perhaps we should start now. Nurse midwives commonly inform women to avoid sexually transmitted infections to protect their babies from acquiring those diseases. We tell them the woman and her partner it is important to protect themselves from sexually transmitted infections STIs , to use condoms, and if they are diagnosed with STIs, they should be treated. We also tell them about the effects of having these diseases. A baby can be born with these diseases. NM: RNM, age 32, with 7 years of experience. They do not talk about other diseases acquired through sexual intercourse, when you are tested for HIV, you are only told your blood is safe just be careful. The use of medicine was also discussed, as it may cause adverse effects if used without medical advice. Women recalled being informed not to use medicine without medical advice. Nonetheless, a few were told that they could use nonprescription drugs such as Panadol and blood increasing medications, but they needed to seek medical advice for drugs that required a prescription. They did not recall talking about the use of alternative medicine, which is a common thing in our setting, where different herbs can be used during pregnancy. One of the problems that need to be monitored during pregnancy is stress, which may lead to depression if not well managed. Anxiety in pregnancy is associated with shorter gestation and has an adverse effect on fetal neurodevelopment and child outcomes. Women were not informed about coping with stress and its management. You may decide to go and tell someone and end up getting bad advice. PW: Age 43, Multi: Para3. I am not sure if we have ever talked about pregnancy-related stress and depression. We found that women perceived their communication and interaction with midwives to be free throughout, and nurse midwives thought that women were free to ask questions. Both midwives and women reported personality differences as both facilitators and barriers to effective communication, as some women feared interacting with midwives and some midwives were difficult to approach. Nurse-midwives believed that communicating with women respectfully and with dignity was important in building trustworthiness. All women were given information about antenatal care, but not all women recalled receiving all the information as per national and international guidelines. Inadequate numbers of staff and inadequate time for the provision of information to the substantial number of pregnant women attending the ANC clinic were perceived to contribute to poor antenatal care information delivery. Friends and relatives were indicated to complement the lack of ANC information. However, some of the information concerning antenatal care given by them was misleading. Effective communication and interactions between nurse-midwives and pregnant women is the key to delivering adequate and useful health information. It ensures positive relationships, fosters a sense of reassurance, comfort, and warmth. The resultant positive relationship reduces negative emotions and may promote health practices among pregnant women. Most pregnant women believed that interaction with nurse-midwives was good, and they were free to communicate. However, some women thought that some nurse midwives were difficult to interact with due to their busy schedule. Some midwives also thought that some women were shy and did not like to interact with them. Despite this contradictory view, it is possible that some women were afraid of verbal abuse, for instance, if they asked tough questions. A study in the Netherlands also found that women were allowed to call midwives if they had questions, but some hesitated to call, thinking that their questions were minor. Respecting women and taking care of them with dignity is an important aspect in ensuring good interactions with women. Respect and dignity are universal human needs. Pregnant women want a friendly and trustful relationship with their midwife and also midwives who can make them feel at ease, who are friendly, respectful, supportive of their choices, treat them well and seriously, give them sufficient time, clarify information for them, and act professionally. A study done in Iran also raised the issue of respect, compassion, sympathy, being friendly, paying attention, and intimacy as important in ANC care. The problem of hash language and mistreatment of women is even higher during labor and delivery. They need a lot of emphasis. Women and midwives also shared their views on various topics covered during ANC contacts, including nutrition education, pregnancy development and monitoring, danger signs and risk behaviors, and preparation for delivery. Nutrition education provides accurate and evidence-based nutrition knowledge to promote healthy eating for pregnant women. Women need this information to make wise food choices that will supply all the required nutrients and provide sufficient energy for the healthy development of their pregnancy. The WHO guidelines emphasize educating and counseling pregnant women about healthy eating and keeping physically active during pregnancy. Women acknowledged receiving nutrition information in general terms that made it difficult for them to make informed nutrition plans according to their needs. Important topics were not covered in detail, but women were just told to eat a balanced diet and increase their intake of fruit and vegetables. Also, only a few nurse midwives acknowledged giving individualized nutrition education only to women with anemia and other nutrition problems. Other studies also reported that, important specific topics were not covered in detail like vegetables and fruits eating, 45 , 46 leading to inadequate consumption of fruits and vegetables. Exercise is vital for the well-being of pregnant women, and it is associated with improved mood and physical fitness. This may have been due to the fact that most women were peasants and active in their activities of daily living and this may have led to midwives giving less emphasis in this area. Another reason may be a lack of enough time to cover the topic. Enabling pregnant women to recognize danger signs and seek medical help early is one of the important strategies to reduce maternal morbidity and mortality. Women who acknowledged being informed of danger signs were able to mention some of them. Getting information about nutrition, pregnancy and danger signs are not enough to ensure safe delivery unless the women prepare well for delivery. Poor preparation for delivery may lead to complications and even death due to delays in reaching or getting appropriate skilled care. This information helps women to make the appropriate decision for care seeking and increases the chance of women using health facilities. Identification of true signs of labor is the key to making immediate decisions to seek medical services. Many pregnant women were not informed about signs of labor, and they used experience and advice from their mothers and friends. These findings are similar to a study done in Brazil which found that two-thirds of pregnant women were not informed about signs of labor. When this is coupled with transport infrastructure problems and poor preparation due to lack of information, it may cause a delay in seeking the service or in reaching the health facility. Women who receive feedback on the results of their assessment and examination and those who are aware of pregnancy risk behaviors and danger signs are better able to identify potential problems that may affect the development of the pregnancy and the health of the infant and seek care promptly. Nurse-midwives and pregnant women agreed that explanation of tests and examination procedure and results was done to very few women. HIV test was the only test that was mostly explained to most women. The reason for this may be the presence of many tests and examination results that need to be explained so nurse-midwives have to prioritize which one to talk about. The findings are similar to previous studies done in Tanzania where the reason for clinical examination and physical checkups was not explained to women 17 and Uganda where there was a lack of explanation of important clinical and laboratory procedures and linking the tests with preventive information. Risk behaviors during pregnancy include cigarette smoking, alcohol use, marijuana use, illicit drug use, and unprotected sex that led to STIs. This may be caused by nurse midwives assuming that most pregnant women from the coast region do not drink alcohol or smoke cigarettes and it may also be lack of time to cover all the topics. Other issues which were raised very rarely were psychological issues like coping with stress. Despite many pregnant women in developing countries needing more information on psychological issues like coping with stress 1 , 57 very few women in this study were informed about stress management, and nurse midwives did not talk about stress and depression during pregnancy unless if the woman has sign of stress. Relative and friend were reported to play an important part in stress management care. There is a consensus that despite the pregnancy being the normal physiological condition, it is a stressful life event for women. Stress and anxiety in pregnancy are associated with shorter gestation and have an adverse effect on fetal neurodevelopment and child outcomes. The qualitative nature of our research gathered both rich and useful information in the study context. Triangulation of sources of information midwives and women yields providers and customers opinion of the ANC information. Although the findings of this study were not meant to be generalized, they are relevant to other context that have similar social economic status as that of Tanzania. Further, a quantitative research study that will include larger and more diverse samples, as well more settings or contexts could be conducted to enhance the generalizability of the findings. The government and other health care providers need to increase the number of midwives, improve their working conditions and incentives. Also, develop policies that encourage the use of technology, like mobile apps, to help healthcare providers and women communicate easily and as a means of communicating health information to clients. We thank the many individuals who made this study successful, especially the pregnant women and health care providers who participated in our study. As a library, NLM provides access to scientific literature. Int J Womens Health. Find articles by Rashidi Heri. Find articles by Lilian Teddy Mselle. Find articles by Mats Malqvist. Received Nov 22; Accepted May 5; Collection date Open in a new tab. Similar articles. Add to Collections. Create a new collection. Add to an existing collection. Choose a collection Unable to load your collection due to an error Please try again. Add Cancel.

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Buying marijuana Bagamoyo

In The Trees is your Maine-based cannabis, gardening, and lifestyle podcast; created not just for the well-vetted OG's in the garden, but for beginners buying a seed pack to grow their very first garden. Immerse yourself In The Trees with fun features, stoney stories, engaging interviews, and gardening tips we are happy to provide the community! Please give us a listen, subscribe to the show, and check out our website www. Hot off the heels of the last five episodes that we presented as the Maine Sungrower's Series, highlighting some great local growers and breeders from the home state of In The Trees, comes this summarizing episode that is jam packed with some crucial knowledge for you! But it doesn't stop there! This knowledge is brought to you by an all star panel of guests from all over the US! 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Buying marijuana Bagamoyo